Description

IN THE CIRCUIT COURT OF THE THIRTEENTH JUDICIAL CIRCUIT IN AND FOR HILLSBOROUGH COUNTY, STATE OF FLORIDA PROBATE, GUARDIANSHIP AND MENTAL HEALTH DIVISION IN RE: THE GUARDIAN ADVOCACY OF Case No.: ____-CP-_________ Division: _______ A Developmentally Disabled Person/Ward. ________________________________________/ SIMPLIFIED ANNUAL PLAN The undersigned, as the Guardian(s) Advocate of the above-named ward, report(s) to the court as follows: 1a.) The name and address of all places the ward has resided during the preceding year. ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ 1b.) Why is this the best placement for the ward? ________________________________________________________________ ________________________________________________________________ 2.) List all professional medical/mental health treatment the ward has received during the past year (did the ward see a doctor, dentist, or mental health professional, if so when?): _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ ________________________________________________________________ 3.) What is/are the ward's current condition(s) which cause(s) him/her to continue to need a guardian advocate? _______________________________________________________________ _______________________________________________________________ American LegalNet, Inc. www.FormsWorkFlow.com 4.) What personal and social services were provided for the ward in the past year (i.e., programs attended, vacations, in-home activities, out-of-the home activities, what does the ward like to do for entertainment or in his/her free time)? _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ 5.) In the past year, how has the ward interacted with others, including the guardian(s) advocate and family members (if the ward is not able to interact, state why)? _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ 6.) Should any of the rights previously delegated to the guardian(s) advocate be restored to the ward at this time? If so, identify the specific right(s) [such as to consent to medical treatment, to determine residence, to manage property, etc.] and explain why. _______________________________________________________________ _______________________________________________________________ _______________________________________________________________ ____________________ Date __________________________________ Signature __________________________________ __________________________________ __________________________________ Guardian Advocate Signature, Address & Phone Number Email Address: _____________________ American LegalNet, Inc. www.FormsWorkFlow.com _____ I certify I have provided my attorney of record with a copy of this annual plan (if applicable) (Initial) DELIVERY: The original copy of this Simplified Annual Plan must be filed with the Clerk of the Circuit Court, Probate and Guardianship Division. Mailing Address: Physical Address: P.O. Box 1110, Tampa, FL 33601-1110 800 E. Twiggs St., Tampa, FL 33602 (Edgecomb Courthouse ­ Downtown Tampa) ASSISTANCE: Staff from the 13th Judicial Circuit's ELDER JUSTICE CENTER is available to answer questions about this form. They cannot, however, provide legal advice. The Elder Justice Center is located at 800 E. Twiggs St., Rm. 481, Tampa, FL 33602 (Edgecomb Courthouse ­ Downtown Tampa) and staff can be reached by calling (813)276-2726. American LegalNet, Inc. www.FormsWorkFlow.com